Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics

Renkawitz, Tobias; Weber, Tim; Dullien, Silvia; Woerner, Michael; Dendorfer, Sebastian; Grifka, Joachim; Weber, Markus

doi:10.1016/j.gaitpost.2016.07.011

Cited by 133 publications

(115 citation statements)

References 29 publications

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“…So there seems to be a tolerance interval for the reconstruction of femoral offset, acetabular offset, and leg length within these 5 mm at least. This is in accordance with two previous studies, which showed, that a reduced global femoral offset less than 5 mm, lead to an aggravation in the functional outcome, especially of the abductor muscle strength and that a leg length and offset difference over 5 mm was associated with altered gait kinematics 14,15 . Interestingly, our results show that the discrepancy of one single biomechanical parameter such as leg length, femoral or acetabular offset was not different between patients with and without trochanteric symptoms.…”

Section: Discussionsupporting

confidence: 93%

“…Beside correct component positioning restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. A recent study showed that even leg length and offset differences over 5 mm are associated with altered gait kinematics as measured in gait analysis after THA and thus emphasize the importance of successful biomechanical restoration 14 . Another study showed, that a reduced global femoral offset less than 5 mm, leads to an aggravation in the functional outcome, especially of the abductor muscle strength 15 .…”

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confidence: 99%

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Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Worlicek

Messmer

Grifka

et al. 2020

Sci Rep

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persistent pain around the greater trochanter is a common complication after total hip arthroplasty. Restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. The purpose of this study was to evaluate postoperative differences of these parameters after THA and to analyze their association to greater trochanteric pain syndrome. Furthermore, we aimed to evaluate the clinical relevance of trochanteric pain syndrome compared to patient reported outcome measures. 3D-CT scans of 90 patients were analyzed after minimalinvasive total hip arthroplasty and leg length, femoral and acetabular offset differences were measured. Clinical evaluation was performed three years after THA regarding the presence of trochanteric pain syndrome and using outcome measures. Furthermore, the patients' expectation were evaluated. Patients with trochanteric pain syndrome showed a higher absolute discrepancy of combined leg length, femoral and acetabular offset restoration compared to the non-operated contralateral side with 11.8 ± 6.0 mm than patients without symptoms in the trochanteric region with 7.8 ± 5.3 mm (p = 0.01). Patients with an absolute deviation of the combined parameters of more than 5 mm complained more frequently about trochanteric symptoms (29.2%, 19/65) than patients with a biomechanical restoration within 5 mm compared to the non-affected contralateral side (8.0%, 2/25, p = 0.03). Clinical outcome measured three years after THA was significantly lower in patients with trochanteric symptoms than without trochanteric pain (p < 0.03). Similarly, fulfillment of patient expectations as measured by THR-Survey was lower in the patients with trochanteric pain (p < 0.005). An exact combined restoration of leg length, acetabular and femoral offset reduces significantly postoperative trochanteric pain syndrome and improves the clinical outcome of the patients.

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Section: Discussionsupporting

confidence: 93%

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confidence: 99%

Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Worlicek

Messmer

Grifka

et al. 2020

Sci Rep

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“…Our THR patients showed an increased hip adduction angle that could be due to differences in femoral stem orientation during surgery . In general and regarding the ipsilateral hip, the reconstructing femoral head‐shaft offset correlates with hip stability and wear, abductor function, and postoperative gait kinematics . Based on the greater hip adduction angle during gait, our results may suggest that the perpendicular distance between the line of action of the abduction force and the center of rotation of the hip was changed after THR.…”

Section: Discussionmentioning

confidence: 70%

Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement

Stief

Schmidt

Drongelen³

et al. 2018

Journal Orthopaedic Research

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A total hip replacement (THR) is a common and routine procedure to reduce pain and restore normal activity. Gait analysis can provide insights into functional characteristics and dynamic joint loading situation not identifiable by clinical examination or static radiographic measures. The present prospective longitudinal study tested whether 2 years after surgery a THR would restore dynamic loading of the knee and hip joints in the frontal plane to normal. Instrumented gait analysis was performed shortly before surgery and approximately 2 years after THR on 15 unilateral hip osteoarthritis (OA) patients. 15 asymptomatic matched individuals were recruited as healthy controls. Results showed that abnormal joint loading persisted 2 years after THR. The 2nd external knee adduction moment in terminal stance in the affected (-34%, p = 0.002, d = 1.22) and non-affected limb (-25%, p = 0.035, d = 0.81) was lower compared to controls and thus indicated a shift in the knee joint load distribution from medial to lateral. A correlation analysis revealed that a smaller hip range of motion explained 46% of 2nd knee adduction moment alterations. In contrast, the 2nd external hip adduction moment in terminal stance was postoperatively higher in the affected (+22%, p = 0.007, d = 1.04) and non-affected limb (+22%, p = 0.005, d = 1.05). Here, 51% of 2nd hip adduction moment alterations can be explained with a greater hip adduction angle. Patients with a THR may therefore be at higher risk for abnormal joint loading and thus for the development of OA in other joints of the lower extremities. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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“…Hip offset is a concept which factors in acetabular offset and hip centre of rotation (COR). A leg length/offset discrepancy of more than 5 mm correlates with non-physiological kinematics of gait [ 40 ]. Other detrimental outcomes include low back pain, nerve injury, patient dissatisfaction and increased litigations [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

Computer assisted navigation in total knee and hip arthroplasty

Deep

Shankar

Mahendra

2017

SICOT-J

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Introduction: Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures. Methods: A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction. Results: Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years. Conclusion: Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.

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Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics

Cited by 133 publications

References 29 publications

Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement

Computer assisted navigation in total knee and hip arthroplasty

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